Test 1. Part 2 Flashcards
Fifth Metatarsal - Base - Dorsal surface - 3 attachments:
• 1) peroneus tertius {T} Note: also inserts on the dorsal surface of the shaft • 2) dorsal cuboideometatarsal ligament {R} • 3) dorsal intermetatarsal ligament (to 4th metatarsal) {L}
Medial Cuneiform - Small oval shaped facet
-Lateral surface -anteriorly – for base of second metatarsal
on the first digit the plantar plate is attached to
the deep transverse ligament on the lateral side only.
What is the keystone of the medial arch?
Talus
Retinacula of the Ankle Superior Extensor Retinaculum - Attaches (Medially)
Medially, it attaches to the anterior crest (border) of the tibia and to the medial malleolus
The superior extensor retinaculum binds
The superior extensor retinaculum binds the tendons of the extensor digitorum longus, extensor hallucis longus, peroneus tertius, and the tendon of the tibialis anterior in its synovial sheath.
Intermediate Cuneiform -what forms the base
Dorsal surface
Navicular Plantar surface tubercle
o Tubercle for attachment of spring ligament –>near the middle of the plantar surface
Talus -Trochlea articulates with
• Tibial plafond (inferior surface of tibia) “tibial plaform” • Medial malleolus (of tibia) • Lateral malleolus (of fibula) • Anterior (inferior) tibiofibular ligament • Inferior transverse ligament (deep portion of posterior (inferior) tibiofibular ligament)
First Metatarsal -head -Distal (anterior) surface is
continuous with the plantar surface where the facets for medial and lateral sesamoid bones are located
Talus -Lateral surface–> Lateral process
– inferior tapered, pointed end -This surface has a triangular facet for lateral malleolus -Superiorly the base of the triangular facet is continuous with the trochlea
The deep fascia of the dorsum of the foot is continuous with what and attaches where?
The deep fascia of the dorsum is continuous with the plantar aponeurosis and attaches to the peroneal trochlea, cuboid and the tuberosity of the fifth metatarsal LATERALLY, and the navicular tuberosity, sustentaculum tali and first metatarsal MEDIALLY
Second Metatarsal -base -Medial surface -Ligament Attachments:
• Lisfranc’s ligament {E}
Ossification of Foot Bones - Phalanges
o Each has 2 centers: Diaphysis (shaft) Epiphysis (base)
Navicular–> attached to the lateral and the dorsal surface
lateral calcaneonavicular portion of bifurcate ligament
The extensor digitorum longus tendon of digits two, three, four and five -The central slip passes
distally along the dorsum of the proximal phalanx
The extensor digitorum longus tendon of digits two, three, four and five -The central slip inserts
inserts on the base of the middle phalanx.
Talus • Attaches anteroinferior to lateral malleoolar surface
Lateral talocalcaneal ligament
Dorsalis Pedis terminal branches
at the first intermetatarsal space it divides into its two terminal branches, the deep plantar and the 1st dorsal metatarsal arteries
Sustantaculum tali is located where
Calcaneus -Medial Surface
Third Metatarsal - Base
o 4 articular areas (1 posterior, 1 lateral, 2 medial)
Talus- posterior process -lateral tubercle -When ossification center fails to fuse with the rest of talus
lateral tubercle is anaccessory bone (called os trigonum)
Medial Cuneiform -Posterior surface
Concave Articulates with navicular Facet shaped: like with the corresponding medial facet on the navicular, the shape of the facet can be triangular, pear-shaped or quadrilateral
The bones of the medial arch are?
- First three metatarsals -all three cuneiforms - Navicular -calcaneus -Talus
Calcaneus -Lateral Surface o Third tubercle of peroneal trochlea
-present 40%-50% of time Posterior & superior to retrotrochlear eminence Attachment of calcaneofibular ligament
fibers of the intermediate root continue medially to form
the superomedial and inferomedial oblique bands
On the sole of the foot the superficial veins form
a plantar cutaneous venous arch that drains into the medial and lateral marginal veins.
Although the dorsalis pedis for the most part lies deep to the superficial structures of the dorsum of the foot, it is superficial enough to
demonstrate a pulse
Fourth Metatarsal - Base -Posterior Surface
Quadralateral facet (articulates with cuboid)
Talus - what blends with the neck of the Talus?
Superior surface of the Head of the Talus
Medial Cuneiform -Posterior surface -Articulates with what
-Navicular
Great Toe – Distal Phalanx - Base
Transversely oriented, Large Deviates laterally 15 degrees from the proximal phalanx
Perforating Branch of Peroneal Artery
perforates the interosseous membrane just above the anterior tibiofibular ligament to gain access to the dorsal part of the foot. This perforating artery is usually very small, but can be fairly large and on occasion take over the vascular supply of the dorsal foot.
- Longest of metatarsals, extends more proximal than others
Second Metatarsal
Navicular facet that is either pear, triangular or quadrilateral shaped?
Medial facet. Part of the large articular facet on the anterior surface of the navicular. - articulates with the medial cuneiform
Peroneal notch
Cuboid–> plantar edge marks the beginning of peroneal sulcus
Ossification of Foot Bones - Tarsal bones
o All have primary ossification center o Calcaneus: (2 centers) primary ossification center + epiphysis in posterior extremity
Superfiical Peroneal Nerve The intermediate dorsal cutaneous nerve
has some communication with the lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve divides into the 2nd & 3rd common dorsal digital nerves for intermetatarsal spaces 3 and 4. Each common dorsal digital branch, at the webbing space, divides to give rise to two dorsal digital nerves. Recall that the 10th dorsal digital nerve originates from the lateral dorsal cutaneous nerve.
• The long plantar ligament and cuboid form
an osseofibrous canal for the tendon of the peroneus longus.
1 facet that rests on the spring ligament
Talus–> Head–> Inferior surface articulates with plantar calcaneonavicular (spring) ligament [p] • Fibrocartilage – Superior portion of spring ligament -> where head of talus rests
Function of the Lumbrical Muscles
On contraction, they tighten the wing and loosen the sling allowing the more proximal parts of the extensor expansion to permit flexion at the metatarsophalangeal joint while holding more distal joints in extension. It should be noted that the flexor digitorum longus muscle, because of its relationship with the lumbricals, DOES contribute to the function of the extensor hood.
Branches from the proximal part of the lateral tarsal artery provide
vascular supply to the head and neck of the talus. Smaller branches supply the other tarsal bones and intertarsal joints
cuboid –> anterior surface
o Vertical ridge – separates two facets Medial facet • Quadrilateral, articulates with base of fourth metatarsal Lateral facet • Triangular with apex laterally directed–> articulates with fifth metatarsal
Extensor Expansion of the Hallux wing and sling–> on the lateral side they are formed by
the adductor hallucis and flexor hallucis brevis.
Inferior Extensor Retinaculum -The laterally directed stem of the “Y” is named what and attaches where
The laterally directed stem of the “Y” (frondiform portion), forming the lateral root of the ligament, is attached to the dorsal and anterior aspect of the calcaneus just anterior to the sulcus calcanei.
The first dorsal metatarsal artery provides vascular supply to
the first dorsal interosseous muscle, articular branches to the first metatarsophalangeal joint and the soft tissues around the medial side of the first toe and the adjacent sides of the first and second toes.
- Miscellaneous sesamoid bones within tendons (order of decreasing frequency):
- 1) flexor digitorum brevis to the second toe – at MPJ joint
- 2) flexor digitorum brevis to the fifth toe – at MPJ joint
- 3) tibialis posterior – beneath navicular
- 4) flexor digitorum brevis to the third toe – at MPJ joint
- 5) flexor digitorum brevis to the fourth toe – at MPJ joint
- 6) flexor hallucis longus – at IPJ (interphalangeal joint)
- 7) flexor digitorum longus – at proximal interphalangeal joints:
- frequency in order, toe: 2, 5, 3, 4 (Note: same order as flexor digitorums) Note: “brevis, brevis, Tom, brevis, brevis, Hal, Dick”
- 8) tendons as they cross malleoli
- a) Tibialis posterior
- b) Flexor digitorum longus
- c) Flexor hallucis longus
- d) Peroneus longus
- e) Peroneus brevis Note: “the order virtually goes in order from medial to lateral across the posterior muscle group with exception of the peroneuses being opposite in order. Variation on pneumonic: Tom, Dick, and Hal cross the mall to fetch a Peroneus Lost Bone”
Great Toe – Distal Phalanx - Base -• Plantar surface
o Attachment of flexor hallucis longus (obliquely directed ridge/tuberosity which courses along the entire plantar surface)
The dorsalis pedis, in a majority of cases (____%), can be traced distally across
- 75%
- the talus, navicular, intermediate cuneiform and the base of the second metatarsal bone to the first intermetatarsal space
Fifth Metatarsal - Base - Plantar surface -4 Attachments:
- 1) Flexor digiti quinti brevis (partial origin) {W}
- 2) plantar ligament of the sole (calcaneometatarsal ligament) {X} o Thickening of plantar aponeurosis
- 3) plantar cuboideometatarsal ligament {S}
- 4) plantar intermetatarsal ligament {P} Note: abductor os metatarsi digit minimi (accessory muscle) – at times inserts into plantar surface of base {Y}
Fourth Metatarsal - Base - Medial Surface
Oval facet – divided by a ridge • Anterior part – articulates with 3rd metatarsal • Posterior part – articulates with lateral cuneiform
largest cuneiform
medial cuneiform
Second Metatarsal - Base
o Wedged shaped / pyramidal – apex directed plantarly o Borders: dorsal, lateral, and medial
Third Metatarsal -Head -Plantar surface
Groove for flexor tendons
The extensor digitorum longus tendon of digits two, three, four and five - For the fifth digit what contributes to the lateral aspect of the expansion?
For the fifth digit, tendons of the abductor digiti minimi and flexor digiti minimi contribute to the lateral aspect of the expansion.
Navicular Plantar surface
o Continuous medially with navicular tuberosity
There is a great deal of variation in the location and size of the dorsalis pedis artery. It may be very large or so small that it is virtually absent. In cases where the artery is deficient or absent,
, the plantar arteries or the perforating branch of the peroneal artery take over. In case the anterior tibial artery is absent (5%), the dorsalis pedis then usually originates from the perforating branch of the peroneal artery.
Dorsal Metatarsal Arteries 2 to 4 The arteries are numbered 2 to 4 from the medial to lateral side. At the proximal end of the interosseous spaces they receive
receive the posterior perforating branches of the plantar arch. At the distal end of the interosseous space, the dorsal metatarsal arteries receive the anterior perforating branches from the plantar metatarsal arteries.
Third Metatarsal -base -articular areas -Medial Surface
• Two demarcates (1 dorsal, 1 plantar)- articulates with 2nd metatarsal • Attachment: interosseous intermetatarsal ligament {J}
Navicular - Anterior Surface o Large articular facet
– divided into 3 articular surfaces (for cuneiforms) by 2 vertical crests/ridges All articulate with appropriate cuneiform bones • Medial facet – largest. It is either pear, triangular or quadrilateral shaped • Middle (intermediate) facet – triangular • Lateral facet – triangular
Dorsalis Pedis Branches
- Lateral tarsal
- Medial tarsal
- Arcuate
- 1st dorsal metatarsal artery
- Deep plantar There are many other unnamed muscular and nutrient twigs that arise from the dorsalis pedis as it works its way towards the 1st interosseous space. Other small branches arising from the dorsalis pedis, along with branches of the lateral tarsal and arcuate arteries, form an anastomotic network (rete) along the dorsum of the foot
Fifth Metatarsal - Base - Medial surface
Triangular or oval facet (articulates with 4th metatarsal) -1 Attachment: • 1) interosseous intermetatarsal ligament {J}
Arcuate Artery In about ____% of cases, this artery originates from the ______ at the level of the_______
In about 65% of cases, this artery originates from the dorsalis pedis artery at the level of the first tarsometatarsal joint. In other cases, its origin can be slightly more proximal and, therefore, it can be confused with the distal lateral tarsal artery
Intermediate Cuneiform – Anterior Surface
-Triangular facet – articulates with 2nd metatarsal
Medial Cuneiform -Plantar Surface - Ligament attachments
Ligament Attachments: • 1) plantar cuneonavicular • 2) plantar intercuneiform • 3) plantar cuneometatarsal (to first metatarsal) • 4) plantar cuneometatarsal (to second metatarsal)
Extensor Expansions -Long and short extensor tendons are held in place by two fibrous sheaths. These sheaths are continuous with ____ and form ____
each other and form a strong fibrous structure called the extensor hoods.
At the ankle joint, the anterior tibial artery continues onto the dorsum of the foot as
the dorsalis pedis artery The name change happens at an imaginary line joining the medial and lateral malleoli (transmalleolar line).
First Metatarsal
- Thickest, heaviest, strongest, short shaft (shortest of the 5)
Talus- posterior process -lateral tubercle has what attachments?
1. Posterior talofibular 2. Posterior talocalcaneal 3. Fibulotalocalcaneal
Inferior Extensor Retinaculum -The superolateral oblique band extends
extends from the superomedial oblique band and frondiform ligament laterally to attach on the lateral surface of the lateral malleolus. -It merges with the superior extensor retinaculum and the superior peroneal retinaculum.
Extensor Expansion of the Hallux
On the first digit, only the tendon of the extensor hallucis longus is attached to the extensor expansion. The plantar plate is attached to the deep transverse ligament on the lateral side only. A wing and sling are present, but lumbricals and interossei do not contribute to them. On the medial side they are formed by the abductor hallucis, while on the lateral side, they are formed by the adductor hallucis and flexor hallucis brevis.
prevent bow stringing of the tendons of the extrinsic muscles of the foot.
retinacula
Calcaneus -Lateral Surface o Peroneal trochlea
-present 33% of time -Ridge of bone – formed by groove for peroneus longus tendon lies inferior & posterior to the Peroneal trochlea
Medial Cuneiform -Plantar Surface -muscle insertions
Partial muscle insertions: • 1) Tibialis anterior • 2) Tibialis posterior • 3) Peroneus longus
Extensor Expansions -what contributes to the formation of the sling but not of the wing?
. Interosseous muscles
Nerves of Dorsum of Foot Saphenous Nerve
The saphenous nerve, a sensory branch of the femoral nerve, follows the great saphenous vein in the leg along its lateral side and enters the dorsum of the foot anterior to the medial malleolus. It courses along the medial border of the foot as far as the first metatarsal bone. It innervates the skin along the medial side of the foot as far as the bse of the 1st metatarsal bone.
From its origin, the arcuate artery runs
runs laterally across the bases of the second, third and fourth metatarsal bones. The tendons of the extensor digitorum brevis cross its superficial surface. On the lateral side of the foot, it anastomoses with the lateral tarsal and lateral plantar arteries. While the arcuate artery is crossing the foot from the medial to the lateral side, it gives rise to the 2nd, 3rd and 4th dorsal metatarsal arteries.
Calcaneus -Lateral Surface
o Broader posterior vs. anterior o Most variable surface (1, 2, or 3 tubercles)
Talus- posterior process -lateral tubercle
o larger than medial
Extensor Digitorum Brevis Nerve
The lateral terminal branch of the deep peroneal nerve is the most common innervation of this muscle. However, when an accessory peroneal branch of the superficial peroneal nerve is present (20% of cases) it usually aids in innervating the muscle.
Fourth Metatarsal - Base - Lateral Surface
Large Triangular or Oval, large facet – articulates with 5th metatarsal 1 Attachment • 1) interosseous intermetatarsal ligament {J}
most typical cuneiform (most similar to wedge shaped)
intermediate cuneiform
The extensor digitorum longus tendon of digits two, three, four and five -The two lateral slips converge over the distal end of the middle phalanx. These rejoined tendinous slips pass
These rejoined tendinous slips pass distally as the terminal slip to insert on the base of the distal phalanx
Fourth Metatarsal - Base - Plantar surface
Attachments:
- (Origin) Adductor hallucis (oblique head) {O} Note: plantar bases 2nd and 3rd metatarsal, other locations for origin
- Tibialis posterior {N}
- Long plantar ligament {M}
- Plantar cuboideometatarsal ligament {S}
- 1) plantar intermetatarsal ligament (to 3rd metatarsal) {P}
- 2) plantar intermetatarsal ligament (to 5th metatarsal) {P}
Calcaneus -Medial Surface
o Deeply concave – plantar nerves & vessels lie within the cave
o “M” Medial head of quadratus plantae attaches to medial surface (more extensive attachment than to medial process (plantar surface))
-Lisfranc’s ligament
-medial Cuneiform -Lateral surface -(interosseous tarsometatarsal ligament) o Attached to the lateral surface of medial cuneiform + second metatarsal
Medial Cuneiform -Lateral Surface -Ligament Attachments
2 ligament attachments • Lisfranc’s ligament (interosseous tarsometatarsal ligament) o Attached to the lateral surface of medial cuneiform + second metatarsal • Interosseous intercuneiform ligament (to intermediate cuneiform)
Lesser Toes o Bases:
Oval facets (articulate with metatarsal heads)
Fifth Metatarsal - Base - Posterior surface
Triangular facet (articulates with cuboid)
The deep fascia divides the dorsum of the foot into _____ layers arranged from superficial to deep
three
Third Metatarsal -base o Dorsal Surface
3 ligament attachments • 1) dorsal intermetatarsal ligament (to 2th metatarsal) {L} • 2) dorsal intermetatarsal ligament (to 4th metatarsal) {L} • Dorsal cuneometatarsal ligament (to lateral cuneiform) {C}
smallest of seven tarsal bones
intermediate cuneiform
Second layer of the deep fascia (dorsum of the feet) contains
the extensor digitorum brevis muscle
First Dorsal Metatarsal Artery The medial branch
courses medially over the head of the first metatarsal bone and deep to the tendons of extensor hallucis longus and brevis to vascularize the medial side of the great toe as the first dorsal digital artery
o Tuberosity for tibialis posterior
Navicular–> Medial surface -Sometimes the tuberosity develops froms a secondary ossification center that does not unite with the rest of the Navicular. Results in an accessory bone the os tibiale (externum)
Talus- posterior process -lateral tubercle has it’s own
secondary ossification center
Superficial Veins of the Foot . The medial marginal vein is formed by
by the union of the medial dorsal digital vein of the first toe and the medial end of the dorsal venous arch.
Cuneiform Bones -Apices
Medial cuneiform – dorsally directed Intermediate & lateral – plantarly directed
Talus -Medial surface–>inferior to articular facet
-Rough surface for the attachment of Anterior tibiotalar ligament (part of deltoid ligament) -• Many vascular foamina inferior to the comma shaped facet (articular facet)
Superfiical Peroneal Nerve The medial dorsal cutaneous nerve of the foot
communicates with the saphenous nerve and on occasion, with the medial terminal branch of the deep peroneal. It gives rise to one dorsal digital branch (1st dorsal digital nerve) and one common dorsal digital branch (1st common dorsal digital nerve). The 1st dorsal digital nerve innervates the medial side of the great toe. The 1st common dorsal digital branch courses to the space between toes two and three, where it divides into the 4th and 5th dorsal digital nerves
Intermediate Cuneiform -Lateral surface
o Articular facet – smooth, elongated oval shaped (vertical direction) o Non-articulated area – attachment of interosseous intercuneiform ligament (with lateral cuneiform)
Lateral Cuneiform - Plantar Surface - muscle attachments
1) flexor hallucis brevis 2) tibialis posterior
Fourth Metatarsal - Shaft
o Triangular in shape (cross section) o 3 Surfaces: dorsal, lateral, medial Note: same general shape as shafts of 2nd and 4th metatarsals
cuboid –> anterior surface–> lateral facet
o Vertical ridge – separates two facets (this is one, medial is other) • Triangular with apex laterally directed–>articulates with fifth metatarsal
Cuboid- Lateral surface -on plantar edge
Peroneal notch
Dorsal Metatarsal Arteries 2 to 4 In the absence of the arcuate artery
, the posterior perforating arteries are usually larger and give rise to the 2nd, 3rd and 4th dorsal metatarsal arteries.
Ossification of Foot Bones - Metatarsals
o Each has 2 centers: Diaphysis (shaft) – appears during fetal life Epiphysis • 1st metatarsal (base) – appears during year 3 • 2-5th metatarsals (head) – appears during years 5-8
Cuboid - Bone direction/orientation:
-Superior surface – superolateral -inferior surface – inferomedial
Lesser Toes - Plantar surface
2 plantar tubercles (1 medial, 1 lateral) • Toe 2: Both for dorsal interossei • Medial Plantar tubercle o Toes 3-5: for plantar interossei • Lateral Plantar tubercle o Toes 3, 4: for dorsi interossei o Toe 5: abductor digiti quinti + flexor digit quinti (brevis)
Second Metatarsal -base -Medial surface
Oval, small facet – articulates with medial cuneiform Note: Occasionally, second oval, small facet is located anterior & inferior to the facet for the medial cuneiform (variable occurance). It is a pressure facet for first metatarsal – formed by contact between the bones
In some cases (_____% ) the artery to the sinus tarsi originates from the lateral tarsal artery.
20-30%
Metatarsal Bones
- 5 metatarsal bones (miniature long bones)
Intermediate Cuneiform -Plantar Surface
o Is the apex of the wedge
o Rather thin surface and therefore a crest
o Attachments:
1) plantar cuneonavicular ligament
2) plantar intercuneiform ligament (to medial cuneiform)
3) plantar intercuneiform ligament (to lateral cuneiform)
Tibialis posterior (partial attachment) Note: there is no ligament attachment from this cuneiform to a metatarsal plantarly (picked up by medial & lateral cuneiform ligaments)
Cuboid -Coronoid process “beak”
-Inferior Surface (plantar surface) -located at point where medial and posterior borders meet
A dorsalis pedis pulse can be taken while the artery is passing
anterior to the tarsal bones, between the tendons of extensor hallucis longus medially and extensor digitorum longus laterally. Often, if the pulse cannot be detected, it is because the anterior tibial artery after giving off its malleolar branches terminates as a small twig at the ankle joint. In this case the perforating branch of the peroneal artery, which lies more laterally, vascularizes the area of the dorsum of the foot normally supplied by the dorsalis pedis
Superior Extensor Retinaculum blends with
. It blends with the superior peroneal retinaculum LATERALLY, and with the proximal border of the inferior extensor retinaculum and the flexor retinaculum MEDIALLY.
Lateral Cuneiform - Plantar Surface -ligament attachments
1) plantar cuneocuboid 2) plantar cuneonavicular 3) plantar intercuneiform 4) plantar cuneometatarsal Note: one to each bone that surrounds this cuneiform.
Cuboid Peroneus longus tendon lies
-in peroneal groove or against anterior part of peroneal ridge
Retrotrochlear eminence origin
-Calcaneus -Lateral Surface -bony trabeculae within calcaneus that fan out from articular surfaces
Deep Veins of the Foot The anterior tibial vein (s) originates from
the venous plexus along the dorsum of the foot.
Calcaneus -Lateral Surface most constant feature
o Retrotrochlear eminence
Cuboid Peroneal sulcus lies
distal to peroneal ridge
part of deltoid ligament
Anterior tibiotalar ligament
Medial Cuneiform -Posterior surface -shape
Concave
Where is a large Ovoid, convex facet – articulates with navicular
Anterior surface of the Head of the Talus
Talus -Head -Inferior surface
-3 facets 2 facets – articulate with calcaneus • Anterior calcaneal facet(on talus) – articulates with anterior talar facet (on superior surface calcaneus) • Middle calcaneal facet (on talus) – articulates with middle talar facet (on superior surface calcaneus) 1 facet that rests on the spring ligament– articulates with plantar calcaneonavicular (spring) ligament [p] • Fibrocartilage – Superior portion of spring ligament -> where head of talus rests
First layer of the deep fascia (dorsum of the feet) contains
the tendons and accompanying synovial sheaths of the tibialis anterior, extensor hallucis longus, extensor digitorum longus and peroneus tertius muscles.
Cuboid
- Lateral bone – distal row tarsals
Talus o Posterior surface aka
posterior process
Talus -Articular Facet
-Medial surface -(Comma-shaped facet – located superiorly) – articulates with medial malleolus “comma in the medial of a sentence”
o 2 tendon attachments – inferiorly near plantar surface: 1) Tibialis anterior (medial surface) 2) Peroneus longus (lateral surface)
First Metatarsal -base–>tendon attachments
Intermediate Cuneiform - Ligaments attached to the dorsal surface
1) dorsal cuneonavicular 2) dorsal intercuneiform (to medial cuneiform) 3) dorsal intercuneiform (to lateral cuneiform) 4) dorsal cuneometatarsal Note: there is a ligament to each of four bones bordering this cuneiform dorsally
o Smallest surface of cuboid (more of a border)
-Lateral surface
- 8) tendons as they cross malleoli
a) Tibialis posterior b) Flexor digitorum longus c) Flexor hallucis longus d) Peroneus longus e) Peroneus brevis Note: “the order virtually goes in order from medial to lateral across the posterior muscle group with exception of the peroneuses being opposite in order. Variation on pneumonic: Tom, Dick, and Hal cross the mall to fetch a Peroneus Lost Bone”
structures attached to plantar surface of the cuboid
o 8 ligament attachments: 1) Long plantar [24] 2) Short plantar [25] 3) Tibialis posterior [27] 4) Flexor hallucis brevis [29] 5) Plantar cuneocuboid 6) Plantar cuboideonavicular 7) plantar cuboideometatarsal to fourth metatarsal 8) plantar cuboideometatarsal to fifth metatarsal
Navicular –> Lateral surface
o Narrow, edge like
Medial Cuneiform -Medial Surface
Quadrilateral shape Often palpable subcutaneously NO bone-bone articulations on this surface – still has a small anterior-inferior facet
Metatarsal Bones - proximal
o Proximal extremity (base) – articulate with distal row of tarsal bones
Retinacula of the Ankle Superior Extensor Retinaculum - Attaches (laterally)
The superior extensor retinaculum (ligamentum transversum cruris; superior part of the anterior annular ligament) attaches laterally to the distal end of the fibula on its anterior border, and on the lateral surface of the lateral malleolus
Third Metatarsal -base -articular areas -Posterior Surface
• Triangular facet (articulates with lateral cuneiform)
Third Metatarsal -Head
- Trochlear, convex shape -Articulates with base of proximal phalanx Note: Head is similar to those of other metatarsals.
Fourth Metatarsal - Head -Plantar surface
Groove for flexor tendons
Fifth Metatarsal - Base - Plantar surface - Groove
abductor digiti quinti (groove made by this tendon
